286 Full

Perspective
LS Gilchrist, PT, PhD, is Associate

Professor, Doctor of Physical Therapy Program, College of St Catherine, 601 25th Ave S, Minneapolis,
MN 55454 (USA), and Clinical Research Scientist, Childrens Hospitals and Clinics of Minnesota, Minneapolis, Minnesota. Address all
correspondence to Dr Gilchrist at:
lsgilchrist@stkate.edu.
ML Galantino, PT, PhD, is Professor
of Physical Therapy, Richard Stockton College of New Jersey, Pomona,
NJ, and Adjunct Research Scholar,
University of Pennsylvania, Philadelphia, Pennsylvania.
M Wampler, PT, DPTSc, is Physical
Therapist, Harrison Medical Center, Bremerton, Washington.
VG Marchese, PT, PhD, is Assistant
Professor, Department of Physical
Therapy, Lebanon Valley College,
Annville, Pennsylvania, and Assistant Professor of Pediatrics, Penn
State Hershey College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
A Framework for Assessment in

Oncology Rehabilitation
Laura S Gilchrist, Mary Lou Galantino, Meredith Wampler, Victoria G Marchese,
G Stephen Morris, Kirsten K Ness
Although the incidence of cancer in the United States is high, improvements in early
diagnosis and treatment have significantly increased survival rates in recent years.
Many survivors of cancer experience lasting, adverse effects caused by either their
disease or its treatment. Physical therapy interventions, both established and new,
often can reverse or ameliorate the impairments (body function and structure) found
in these patients, improving their ability to carry out daily tasks and actions (activity)
and to participate in life situations (participation). Measuring the efficacy of physical
therapy interventions in each of these dimensions is challenging but essential for
developing and delivering optimal care for these patients. This article describes the
acute and long-term effects of cancer and its treatment and the use of the World
Health Organizations International Classification of Functioning, Disability and
Health (ICF) as a basis for selection of assessment or outcome tools and diagnostic or
screening tools in this population.
GS Morris, PT, PhD, is Director of

Clinical Research in Rehabilitation
Sciences, The University of Texas
MD Anderson Cancer Center,
Houston, Texas.
KK Ness, PT, PhD, is Assistant
Member, Department of Epidemiology and Cancer Control, St
Jude Childrens Research Hospital,
Memphis, Tennessee.
[Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286 306.]
2009 American Physical Therapy
Association
Post a Rapid Response or

find The Bottom Line:
www.ptjournal.org
286
Physical Therapy
Volume 89
Number 3
March 2009
Assessment in Oncology Rehabilitation
ancer has a high incidence in

the United States, where 46%
of all males and 41% of all females can expect to develop either
an invasive or in situ cancer.1 An
estimated 1.4 million new cases of
cancer are diagnosed each year, with
nearly 13,500 of these cases occurring in individuals younger than 20
years of age.2 In years past, survival
following a diagnosis of cancer was
problematic; however, dramatic
progress in the ability to diagnose
cancers earlier and to provide moreeffective and targeted treatments has
led to substantial increases in survival. The National Cancer Institutes
Surveillance, Epidemiology, and End
Results Program estimates that 65.3%
of adults diagnosed with cancer between the years 2001 and 2005 will
survive for at least 5 years.1 In addition, about 80% of people younger
than 19 years of age who are diagnosed with cancer today are expected to survive for 5 years or longer.1,3 All told, an estimated 10 million
people are living in the United States
today who have or have had a diagnosis of cancer.1 As the population
ages and treatments improve, these
numbers are expected to continue to
rise. Currently available medical interventions for cancer are designed
to eliminate or control disease by
suppressing cell growth (chemotherapy, irradiation) or directly removing
the tumor (surgery).4 15 These treatments may lack specificity and can
damage normal tissue.16 19 Thus,
cancer is no longer an acute disease,
with mortality as the primary outcome. Rather, treatment successes
have made cancer a chronic disease,
with many survivors developing significant sequelae to either the disease itself or to the treatment.20 23
Oncology rehabilitation has long
been a part of the management of
cancer, but with increased survivorship, these efforts have evolved from
simple supportive and palliative care
to now include complex rehabilitaMarch 2009
tion interventions designed to restore the integrity of organ structure

and function, to remediate functional loss, and to adapt to the environment so as to allow full participation in daily activities and life roles.
In the current medical environment,
demonstrating treatment efficacy by
means of quantifiable outcome measures is increasingly important. As
such, the expansion of interventions
provided to patients with cancer and
survivors of cancer must be accompanied by the appropriate application of new and existing measures.
Because the information generated
by these tools may be seen by many
health care professionals and can extend across broad spans of time, the
utility of such information is greatest
when it is presented within a framework of standardized language and
concepts. Such a framework can be
found in the International Classification of Functioning, Disability
and Health (ICF).24 This classification system is designed to describe
health and health-related status from
biological, personal, and societal perspectives. Disorders across the domains of body structure and function, activities, and participation are
referred to as impairments, limitations, and restrictions, respectively.
Functioning is an umbrella term
that encompasses these 3 domains.
Health conditions or disease states,
personal factors, and the environment interact with these constructs
to determine whether disordered
functioning will result in disability.24
The primary purpose of this article is
to use the ICF framework and its
language to describe outcome measures and diagnostic screening tools
that the rehabilitation therapist will
find useful in assessing patients with
an oncology diagnosis. Some of these
outcome measures may be new to
therapists; others may already be
part of their routine assessment.
However, factors unique to a diagnosis of cancer or to its treatment may
influence how and when such routine measures are used. Thus, the
second purpose of this article is to
provide greater understanding of
the clinical issues common to the
oncology population. Collectively,
we hope to improve clinical care,
facilitate communication across different rehabilitation disciplines, and
encourage further study in the area
of oncology rehabilitation.
The ICF Function

Classification Framework
The ICF was developed by the
World Health Organization24 to provide a framework to describe health
and health-related states and to suggest standardized language to describe these states. The ICF framework (Figure) is increasingly being
used in the rehabilitation field and
has recently been endorsed by the
American Physical Therapy Association (APTA) House of Delegates for
incorporation into all relevant Association publications, documents, and
communications.25
Based on the work of Nagi,26,27 the
ICF model shifts the focus of disablement from cause to impact, from disability to health and function, and
from a static process to a dynamic
process.24,28 As stated previously,
the ICF defines 3 domains of human
function (Figure): body function and
structure, activity, and participation.
Body function and structure refers
to the anatomical and physiological
function of the body systems, and
these body functions and body structures are categorized into the subdomains listed in the Figure. Deficits
in this domain are called impairments (eg, muscle weakness, restricted joint motion, poor cardiorespiratory fitness) and often are
identified, measured, and treated by
physical therapists. The activity domain describes the ability of an individual to perform specific tasks such
as sweeping the floor, raking the
yard, or putting away groceries. Dec-
Volume 89
Number 3
Physical Therapy f
287
Figure.
International Classification of Functioning, Disability and Health (ICF) model24 modified for populations of people with cancer. Modified
and reprinted with permission of the World Health Organization from: International Classification of Functioning, Disability and Health:
ICF. Geneva, Switzerland: World Health Organization; 2001.
rements in the activity domain are

called limitations and describe the
difficulty an individual has performing a particular task.24 Physical therapy goals often are aimed at reversing or normalizing such activity
limitations. The participation domain
describes the ability of a person to
be involved in life situations. Participation restrictions describe the reduced ability of a person to maintain
normal role functions and interact
with society.24,29,30 Physical therapy
interventions are designed, directly
or indirectly, to enhance participation levels for every client at home,
288
Physical Therapy
Volume 89
school, or work; on the athletic field;

or in any community setting. The
activity and participation subdomains are given as a single list (Figure), and their use will be discussed
in the Measurement of Activity and
Participation section of this article.
In the ICF model, health conditions,
personal factors, and the environment interact dynamically across the
3 domains of body function to help
determine whether disordered function results in disability. For example, if a cancer treatment (eg, chemotherapy) causes a patient to
Number 3
develop unresolved peripheral neuropathy and ankle weakness,31 this

patient may have a limited ability to
walk (limitation) and may require
long-term use of an ankle brace. Limited ability to walk could result in an
employment restriction for a firefighter, but not for a computer programmer. Participation restrictions
occur when activity limitations cannot be sufficiently overcome to
maintain role functions in the persons normal environment.29,30
Formal work is emerging that uses
the ICF classification scheme to deMarch 2009

scribe overall function of populations who have specific chronic
health conditions, including, but
not limited to, multiple sclerosis,32
stroke,33,34 osteoarthritis,35 diabetes,36
low back pain,37 obesity,38 osteoporosis,39 and rheumatoid arthritis.40,41 This growing body of literature uses the ICF framework to
identify measurements relevant to a
specific illness. The ICF Core Sets
provide clinicians and researchers
with comprehensive but concise measurement categories that describe a
patients global function from a biopsychosocial view. Some investigators42 46 have used the ICF Core Sets
as the comparison standard for the
assessment of function and disability
when evaluating the content of a
previous or newly developed measurement tool.
A limited number of ICF Core Sets
have been developed for patients
with head and neck cancer47 and
breast cancer.48 Although the ICF
Core Sets have not been widely used
in the US physical therapy or oncology communities, the ICF framework is a useful model for describing global function in patients with
a new or previous cancer diagnosis.49 Consideration of the interaction among cancer as a health condition, impairments in body function
and structure, activity limitations,
and participation restrictions in the
context of the person and the environment are essential to the design
of an effective oncology rehabilitation intervention.50
Selecting Appropriate
Measures
In this article, we describe measures
as potential descriptors of particular
ICF function domains. We encourage therapists to use this schema to
assist them in deciding which measures to include in their baseline,
continuing, and final outcome assessments of their patients and clients.
To do this, the therapist should reMarch 2009
view the primary goals of the intervention and determine how these
goals fit into the ICF domains. That
is, which of the ICF domains is the
intervention intended to affect? If
the intervention is designed to make
a change at the tissue level, then the
appropriate measure would assess a
specific change at the body function
and structure level. For example, a
patient with restricted shoulder mobility (decreased range of motion
[ROM]) after a mastectomy may be
treated with a regimen of stretching
and scar tissue mobilization where
the intended outcome is lengthened
tissue, making ROM an appropriate
measure. By increasing ROM, this
intervention also may improve the
patients ability to reach overhead,
making certain daily tasks possible
(an activity-level measure), which, in
turn, may increase the patients ability or willingness to engage in life
activities such as work or education
(a participation-level measure). In
this example, outcome measures at
each level would be appropriate, and
such information would speak to the
efficacy of the intervention across
functional domains.
Selecting an outcome measure also
requires consideration of the psychometric properties of the instrument or tool the therapist is planning to use. Validity, reliability, and
responsiveness are 3 properties the
therapist should consider.51 The
measure should make sense (face
validity), be accepted by experts in
the field (content validity), and correlate with an expected outcome
(predictive validity) and with other
measures that evaluate the same construct (concurrent validity). The instrument should yield the same results (reliability) when repeated by
separate examiners (interrater reliability), by the same examiner on the
same patient (intrarater reliability),
or on separate occasions within a
time period when no changes would
be expected (test-retest reliability).
The therapist also will want to select

an instrument that is capable of detecting change resulting from an intervention (responsiveness).51 Instruments that place individuals into
a limited number of categories,51
such as the Functional Independence Measure,52 tend not to be responsive because very large changes
are required to move from one category to another. Additionally, instruments should not have a ceiling effect. If many respondents initially
score at the highest level, there is no
room for improvement, and change
will not be detected.51
It is important to understand that the
psychometric properties of validity
for diagnostic and screening measures are different than for outcome
measures.53 Clinicians need to know
how accurate the diagnostic tool is
in identifying the presence or absence of the target condition. Often
a new tool is compared with a gold
standard, and its validity is described
using sensitivity and specificity. Sensitivity, often referred to as a true
positive rate, is defined as a tests
ability to correctly identify the target
condition when the target condition
is present. A high sensitivity is desirable, as it will rarely miss someone
who has the condition. Specificity
describes a tests ability to identify
those without the target condition
who really do not have the target
condition, a true negative rate. If
an instrument has a high specificity,
then this instrument will rarely test
positive when a person does not
have the disease (ie, a low chance of
false positive predictions).
In this article, we provide examples
of measures that are relevant to particular impairments, limitations, and
restrictions experienced by patients
with cancer or survivors of cancer.
The list is not exhaustive and is not
restricted by documented reliability, validity, or responsiveness of the
particular instrument; however, it
Volume 89
Number 3
Physical Therapy f
289

does include instruments commonly
used by physical therapists, some
specifically developed for oncology
populations. When choosing a measurement tool, the therapist should
investigate its psychometric properties in relation to the population of
interest. The references given in
Tables 1, 2, and 3 provide a starting
point for those searches.
Measurement of Body
Function and Structure
The specific tests and measures used
by the physical therapist to measure
body function and structure in patients with a cancer diagnosis often
are not unique to the assessment of
this population. However, these
measures provide relevant information about cancer-related impairments, prognostic considerations,
and safety factors. This section highlights some common cancer-related
changes in body function and structure and suggests some appropriate measurement tools for assessing
these impairments.
Mental Functions
Mental functions (Tab. 1, Mental
Functions), although not the primary
interest of most physical therapists,
play an important role in determining how best to interact with and provide interventions for our patients.
Both radiation and chemotherapy
can alter the structure and function
of the central nervous system and
may result in impaired mental function in patients during or following treatment for their cancer.54 65
Specific mental function sequelae,
including impaired memory and difficulty with sustained attention (concentration), may be evident years
after treatment.58,66 Proposed mechanisms for these impairments include
chemical toxicity, oxidative damage,
inflammation, and destructive autoimmune responses.67 69 The Mini-Mental
State Examination70 is a simple tool for
screening mental functions and has
been used by physical therapists. Al290
Physical Therapy
Volume 89
though an array of more-complex

and detailed neuropsychological tests
are available to measure the various
domains of cognitive function, information is lacking regarding the sensitivity and specificity of the tests to
detect changes in cognitive function
from chemotherapy. The identification of sensitive neuropsychological
tests is crucial to further understanding of chemotherapy-induced cognitive impairments.71
Emotional functions also may affect
the ability of a patient to participate
in the physical therapy intervention. A tool that has been used to
evaluate emotional functions in patients with cancer is the Profile of
Mood States.72,73 This self-report instrument is easy to use and may provide insight into our patients ability
to respond to and participate in a
physical therapy program.
Sensory Functions and Pain
Table 1 (Sensory Functions and Pain)
describes several potential measures
for vestibular, somatosensory, and
pain impairments. These impairments are common in patients who
are undergoing cancer treatment or
have a history of cancer.
Hearing and vestibular functions
can be affected by tumor growth or
by chemotherapy. Although auditory impairments are infrequently
targets of physical therapy assessment, vestibular impairments and
their relationship to balance dysfunction should be considered. Vestibular schwannoma, a relatively rare benign tumor, can impair vestibular
function, usually unilaterally. Cisplatin, a chemotherapy drug used to
treat many types of tumors (eg, lung,
breast, ovarian) has been associated
with both vestibular toxicity and
ototoxicity.74,75 Tests of vestibular
function can help physical therapists
document change during or after
treatment (Tab. 1). It also is important for therapists to use a measure
Number 3
of balance for patients with these

impairments (see the Neuromusculoskeletal and Movement-Related
Functions and Structures section
for more information on balance
measures).
Treatment-induced peripheral nerve
impairments are common. Several
chemotherapy drugs (ie, taxanes,
platinum agents, vinca alkaloids, and
thalidomide) can damage peripheral
axons and nerve cell bodies.76
Chemotherapy-induced peripheral
neuropathy (CIPN) is characterized
by sensory impairments, including
paresthesias, dysesthesias, decreased
touch thresholds, decreased vibration thresholds, and reduced deep
tendon reflexes.7779 As CIPN worsens, muscle weakness and limb
movement disorders, such as foot
drop, may develop and require the
use of an orthosis. Multidimensional
tests, such as the modified Total
Neuropathy Scale, may be beneficial in fully describing the severity
of CIPN (Tab. 1).77,80,81 Anesthesia
or dysesthesias may occur when
compression or surgical dissection
of a nerve occurs.82 Radiation plexopathies also may occur but are
much less common, as radiation
oncologists have developed techniques to shield delicate neural
structures.83
Many patients with cancer, particularly those with advanced or metastatic disease, have increased levels
of pain.84 Cancer-related pain may
arise from the tumor itself or as a
side effect of treatment. Some forms
of cancer are inherently more painful, specifically any cancer originating in or metastasizing to the bone.
Pain can have a large impact on mobility, and some researchers have
even established cut-points for moderate and severe pain based on its
interference with daily activity.85
Evaluation of pain in this population
is essential and should be multifaceted (Tab. 1, Pain). Although many
March 2009

Table 1.
Measurement Tools for Body Function and Structure, With International Classification of Functioning, Disability and Health (ICF)
Code (Alphabetic Chapter and Numeric Second-Level Domains) in Parentheses
Construct
Measurement Tool
Measurement Characteristics
Representative Studies in
Populations of Patients
With Cancer
Mental functions
Specific mental functions
(b140b152)
High-sensitivity cognitive screen
An interview-based instrument
designed to assess 6 major
domains of neuropsychological
performance: memory,
language, attention/
concentration, visual/motor,
spatial, and self-regulation and
planning148
Prostate cancer149
Mini-Mental State Examination
An 11-item questionnaire that is

used to screen for dementia70
Brain tumor150
Functional Assessment of
Cancer TherapyCognitive
Function (FACT-COG)
A 38-item questionnaire that

addresses cognitive issues
related to treatment. This
instrument assesses an array of
generic and targeted measures
and has multiple benefits,
including validity, ease of
administration and
interpretation, and global
application.151
All populations of patients with

cancer; prostate cancer149
Perceived Cognition
Questionnaire
A self-report scale that rates an

individuals perception of
change in cognition since the
inception of chemotherapy152
Breast cancer152
Profile of Mood States
Measures 6 mood or affective

states: tension-anxiety,
depression-dejection,
anger-hostility, vigor-activity,
fatigue-inertia, and
confusion-bewilderment72,73
Prostate cancer,153
advanced cancer,154
breast cancer,155,156
nonsmall cell cancer,157
head and neck cancer158
Dizziness Handicap Inventory

Questionnaire

allows for self-assessment of the
impact of disequilibrium on
functional activity159
Vestibular schwannoma160,161
Computerized gaze stabilization/

visual acuity tests (eg,
NeuroCom inVision System)
A mechanical test that assesses

patient difficulty in coordinating
eye movements with head
movements. Deficits may
indicate problems with
vestibulo-ocular reflex.162,163
Vestibular schwannoma161
Modified Total Neuropathy

Score
Multidimensional test of
peripheral nerve function79
Breast cancer79
Semmes-Weinstein
monofilaments
Mechanical test that quantifies

touch thresholds164
Breast cancer79
Biothesiometer
Mechanical test that quantifies

vibration thresholds164,165
Breast cancer79
Visual analog scale
Unidimensional measure of pain

intensity166
Lung cancer167
Numeric rating scale
Unidimensional measure of pain

intensity86
Pediatric cancers168,169; mixed

adult population170
Faces Pain ScaleRevised171
Intensity measure appropriate for

children and patients with
cognitive decline171
Pediatric cancers168,169
Sensory functions and pain

Hearing and vestibular
functions (b230b249)
Additional sensory functions

(b250b279)
Pain (b280b289)
(Continued)
March 2009
Volume 89
Number 3
Physical Therapy f
291

Table 1.
Continued
With Cancer
Brief Pain Inventory
Multidimensional measure of pain;

includes intensity and impact
on function88
Adult pain clinic participants,172

prostate cancer,173 bone
metastases174
Pain Treatment Satisfaction Scale

measures patient satisfaction
with pain management89
None
Goniometry
Mechanical measure, with

published normal values175,176
Breast cancer,90,91,177 head and

neck cancer,9294
leukemia,178 osteosarcoma179
Sit-and-reach
Performance test of generalized

flexibility180
Lymphoma,21 breast cancer181
Manual muscle testing
Standardized performance test

that measures the patients
ability to resist against
therapist-applied force
Osteosarcoma101
Handheld dynamometry
Mechanical measure of force

output, with published normal
values98
Leukemia178,182
Grip strength
Mechanical measure of force

output, with published normal
values97
Osteosarcoma,101 breast
cancer,183,184 lymphoma185
Structures related to
movementother
(b750b789)
National Cancer Institutes

Common Terminology
Criteria for Adverse Events,
version 3 (Fibrosis Scale)
This scale provides standardized

language to describe fibrosis of
tissue due to postsurgical
scarring or radiation therapy121
Uterine cancer186
Motor reflex functions

(b750)
Deep tendon reflexes
A mechanical test that can be

performed in isolation, but
often is included in
multidimensional peripheral
nerve tests such as the Modified
Total Neuropathy Score
Breast cancer104
Involuntary movement
reaction functions
(b765)
Computerized posturography
(eg, NeuroCom Sensory
Organization Test)
Computer-based, quantitative
assessment of postural stability
under various sensory
conditions187
Breast cancer,104 vestibular

schwannoma,188,189 prostate
cancer,190 cerebellar tumor191
Gait pattern functions

(b770)
Gait speed
Performance measure of gait

requiring little equipment
Pediatric sarcoma101
Kinematic gait analysis
Quantitative analysis of joint and

limb positions and movement
during gait; can require
expensive equipment
Pediatric brain tumor,103 bone

tumor99
Heart rate
Standard vital sign, with normal

values192
Hospice193
Blood pressure
Standard vital sign, with cut-points

for hypertension and
prehypertension192
Survivors of childhood cancer,194

leukemia,195 testicular
cancer,196 brain tumor197
Construct
Pain (b280-b289)
continued
Measurement Toola
Neuromusculoskeletal
and movementrelated functions
and structures
Functions of the joints
and bones
(b710b729)
Muscle functions
(b730b749)
Functions of the
cardiovascular,
hematologic,
immunologic, and
respiratory systems
Cardiovascular system
(Continued)
292
Physical Therapy
Volume 89
Number 3
March 2009

Table 1.
Continued
Construct
Respiratory system
Additional functions and

sensations of the
cardiovascular and
respiratory systems
aerobic capacity
(b455)
Additional functions and

sensations of the
cardiovascular and
respiratory systems
fatigue (b455)
Immunological system
functions (lymphatic
system) (b435)
Measurement Toola
With Cancer
Respiratory rate
Standard vital sign, with normal

values192
Hospice,193 general cancer

population198
Oxygen saturation
Indirect measure of
oxyhemoglobin level
Lung cancer199
Pulmonary function tests
Direct measures of lung volume

and flow rates
General cancer population,198

post-lung irradiation,200 lung
cancer,199 Hodgkin disease201
Medical Research Council

Dyspnea Scale
Self-report rating of shortness of

breath111
None
Graded exercise testing
Estimate of maximal oxygen

consumption based on exercise
performance192
Breast cancer202204
Duke Activity Scales Inventory
Estimate of maximal oxygen

consumption based on selfreported activity205
None
2- or 6-minute walk test
Performance-based assessment of
exercise tolerance and
functional capacity110
Osteosarcoma,101 leukemia,182
prostate cancer,190 lung
cancer199
9-minute run-walk
exercise tolerance206
Osteosarcoma207
Borg Rating Scale of Perceived

Exertion
Self-report of physical effort

during exercise or activity112
None
Multidimensional Fatigue
Inventory
A 20-item questionnaire with 5

subscales that assesses
self-reported fatigue208
Head and neck cancer209
Functional Assessment of Chronic

Illness TherapyFatigue

assesses fatigue and the impact
of fatigue210
Patients with cancer and severe

pain115
Piper Fatigue Scale
A 26-item multidimensional
fatigue assessment
instrument211
Leukemia,212
breast cancer213
Brief Fatigue Inventory
A 9-item rapid screening tool for

fatigue severity and impact on
function214
Lung cancer,136 leukemia,215

lymphoma,21,215 rectal
cancer216
Limb volume: water

displacement
Direct, mechanical quantitative

measurement of limb
volume117119
Breast cancer117119
Limb volume: infrared

optoelectric technology
Direct, quantitative measure of

limb volume using computer
analysis of a scanned image to
document the diameter of the
extremity along its length217
Breast cancer120
Limb volume estimates: limb

circumferences using a
truncated cone formula
Indirect, quantitative measure of

limb volume117,118
Breast cancer117,118
National Cancer Institutes

Common Terminology Criteria
for Adverse Events, version 3
(lymphatic, integument, and
phlebolymphatic cording
scales)
Numeric scales that use

standardized language to
describe impairments in the
lymphatic, integument, and
phlebolymphatic systems121
Survivors of cancer20
Not intended to be an all-inclusive list of measures, but as examples of measures that have been reported in the oncology literature.
March 2009
Volume 89
Number 3
Physical Therapy f
293

scales, such as visual analog scales
and numeric rating scales,86,87 specifically focus on pain intensity, other
scales are multidimensional and include questions on interference with
daily activity88 or acceptability of
pain treatments.89
Neuromusculoskeletal and
Movement-Related Functions
and Structures
Table 1 (Neuromusculoskeletal and
Movement-Related Functions and
Structures) describes useful measures
for evaluating potential changes in
neuromusculoskeletal and movementrelated functions and structures. Patients with cancer or a history of
cancer may experience a number
of impairments in this subdomain,
including loss of ROM, decreased
strength (force-generating capacity),
gait pattern abnormalities, and balance deficits.
Deficits in ROM may be present in
patients who have undergone surgery, chemotherapy, or radiation therapy. Such deficits may result from
the formation of scar tissue following surgery, disuse of a joint following chemotherapy or surgery, or
fibrosis caused by irradiation. Decreased ROM may occur coincident
with treatment or after the completion of treatment. Seemingly lessinvasive surgeries (lumpectomy versus mastectomy) can affect ROM as
much as more-invasive procedures.90
Decreased ROM also should be considered if radiation treatment has involved a joint.91 This loss of ROM
may occur after radiation is completed and can extend beyond the
immediately irradiated joint. For example, patients who have completed
surgery or radiation for a head and
neck tumor may have impaired
shoulder abduction and flexion in addition to the more obvious loss of
cervical ROM. These problems are
more severe after surgeries involving
radical neck dissections and the re-
294
Physical Therapy
Volume 89
moval of
nerve.9294
the
spinal
accessory
Muscle strength deficits can arise

from tumor-produced inflammatory
intermediates that are catabolic, resulting in muscle wasting (cachexia).95 Surgical interventions also
may damage muscle groups and peripheral nerves, leading to loss of
strength. Radiation and chemotherapy (especially the vinca alkaloids,
taxanes, and platinum agents) can
reduce strength by damaging muscle
or peripheral nerve tissue.91 Corticosteroids preferentially damage proximal limb muscles, limiting activities
such as sit-to-stand and overhead
reaching.96 Additionally, pain, fear,
and fatigue lead to inactivity, which,
in turn, causes further loss of muscle
strength and aerobic capacity. Although techniques for manual muscle testing are widely used by therapists to measure strength, measures
of dynamometry and grip force provide quantitative documentation of
strength deficits.97,98
Cancer or cancer treatments can alter gait characteristics by adversely
affecting the function and structure
of the lower extremity or the nervous system. The few studies that
have assessed these changes have
shown deficits in patients with bone
tumor lesions of the lower extremity
and tumors of the nervous system.99 103 Traditional gait evaluation
tools, such as kinematic analysis or
gait speed measurements, are appropriate for patients with cancer.
Balance can be disrupted in many
patients with cancer or a history of
cancer and may arise from impairments in multiple body systems.
Problems with sensory input, central
processing of balance-related information, ROM limitations, orthostatic
hypotension, and muscle force production can all contribute to this
multifactorial issue. Specific to the
neuromuscular system, patients with
Number 3
taxane-induced peripheral neuropathy have limitations in postural stability.104 It is important for physical
therapists to measure postural control in a variety of challenging positions to detect and treat balance limitations in patients, especially after
chemotherapy. Because the oncology population often is at risk for
falls,105 screening for balance disorders is very important. We have included measures that are intended to
identify balance impairments and
their underlying structural problems
in Table 1 (Measurement Tools for
Body Function and Structure: Involuntary Movement Reaction Functions) and tests that use mobility
skills to rate the level of balance dysfunction in Table 3 (Measurement of
Activity and Participation: Mobility
Changing and Maintaining Body Positions). In either case, in the ICF
model, a balance disorder is classified as a body function and structure
impairment.
Functions of the Cardiovascular,
Hematologic, Immunologic, and
Respiratory Systems
Cardiotoxicity is a well-known late
effect of several chemotherapeutic
agents, particularly the anthracyclines
(Adriamycin*) and trastuzumab (Herceptin). These compounds may damage cardiac myocytes and ultimately
can result in congestive heart failure.106,107 Similarly, radiation striking
the heart can cause cardiac and coronary artery scarring, leading to restrictive cardiac disease and coronary
artery disease.108 In older patients,
these cardiovascular changes may be
superimposed on already existing cardiovascular disease, further amplifying
the impairments associated with this
disease. It is important for therapists to
ask the patients physician for the results of cardiac testing, performed
* Pharmacia Inc, Kalamazoo, MI 49001.
Genentech Inc, 1 DNA Way, South San Francisco, CA 94080-4990.
March 2009

Table 2.
Physician-Performed Diagnostic Measures of Body Structure and Function Indicating Red Flags or Yellow Flags for Physical
Therapists, With International Classification of Functioning, Disability and Health (ICF) Code (Alphabetic Chapter and Numeric
Second-Level Domains) in Parentheses
Construct
Measurement Tool
Measurement Characteristics and

Importance to Physical Therapy
Representative Studies
in Populations of
People With Cancer
Structures of the
nervous system
Magnetic resonance imaginga
Preferred method to detect

compression of neurologic tissue,
(ie, spinal cord, nerve roots, or
nerve plexus) by tumor or unstable
vertebral fractures123
Patients with vertebral

metastases or spinal
cord compression123,218
Dual-energy x-ray
absorptiometrya
Diagnostic test for osteopenia and

osteoporosis
Leukemia,182,219 prostate
cancer190
Radiography or computed
tomography scana
If 25%50% of the cortex of bone is

degraded, then partial weightbearing precautions should be
instituted. If greater than 50% bone
degradation, then touch-down or
nonweight-bearing precautions are
recommended.220
Multiple myeloma220
Hematologic system
functions (b430)
Complete blood count (ie,

hemoglobin, hematocrit,
white blood count,
platelet count)a
Diagnostic test to detect anemia,

neutropenia, and
thrombocytopenia. These values
also are useful in exercise
prescription, particularly in
choosing safe mode and intensity of
exercise.
Patients with stem cell

transplant221
Cardiovascular system
functions
(b410b429)
Echocardiograma
Assesses ventricular function,

including ejection fraction, wall
movement, and cardiac output
Hodgkin disease,222 breast

cancer223
Nervous tissue
(s110s199)
Structures related to
movement
Skeletal system
(s710s770)
Functions of the
cardiovascular,
hematologic,
immunologic, and
respiratory
systems
These tests are performed by a physician, but yield important information for the physical therapist.
both before and after treatment with

cardiotoxic agents (Tab. 2).
Primary tumors of the lung are frequent, with 215,020 new cases estimated for 2008 in the United States.1
These space-occupying tumors cause
respiratory impairments by limiting
the expansion of the thoracic cavity,
compressing the airways, and reducing the surface area of the lungs
available for gas exchange. As these
tumors grow and impinge on other
mediastinal structures, they can decrease cardiac function secondary
March 2009
to cardiac and vascular compression

and cause upper-extremity musculoskeletal injury secondary to brachial
plexus compression and infiltration.
The respiratory system also can be
adversely affected by chemotherapy
and radiation treatment for cancers
not involving the lung. Chemotherapeutic agents such as bleomycin,
methotrexate, and docetaxel can
damage pneumocytes and the pulmonary parenchema.109 Such damage can lead to obliteration of alveoli
and dilation of air spaces. Likewise,
chest wall irradiation can damage

the lining of the alveoli, leading to
toxicities such as pneumonitis and
fibrosis,109 as well as causing fibrosis
of integumentary and musculoskeletal structures that contribute to
ventilation.
Measurements of vital signs (heart
rate, blood pressure, respiratory rate,
and oxygen saturation) provide insight into the cardiorespiratory status of patients with cancer. The
presence of hemodynamic instability
at rest (altered blood pressure, tachy-
Volume 89
Number 3
Physical Therapy f
295

cardia, light-headedness, cyanosis)
suggests that action should be taken
to protect the patient. Impairments
in cardiorespiratory status may manifest themselves only with increased
exertion. For this reason, assessment involving testing under conditions of increased exertional demand
(Tab. 1) is preferred and may involve
formal exercise testing, self-report of
activity levels, or results from a
6-minute walk test or similar aerobic capacity test.110 Failure to meet
normal range values for these assessment tools suggests impaired cardiovascular and respiratory function. Patient report of breathing difficulties
(Dyspnea Scale111) and of exertional
demand (Borg Rating of Perceived
Exertion112) during a 6-minute walk
test provide further insight into
these impairments.
Fatigue is a well-documented, multisystem impairment commonly reported in a wide variety of cancers,
both acutely and long after cancer
treatments have ended.113 Exercise is
an effective intervention for cancerrelated fatigue, and it is recommended that a multidimentional
measure be used to capture the physical, emotional, and mental aspects
of fatigue.114 One such measure is
the fatigue subscale of the Functional Assessment of Chronic Illness
Therapy (FACIT-F), which initially
was developed for the oncology population and has been used in patients
with a variety of cancer types115 and
in survivors of cancer.116
In the ICF, the function of the lymphatic vessels and nodes are classified under immunologic function.
Defects may involve tumor obstruction of lymphatic vessels, but they
more likely occur secondary to surgical resection of lymph nodes or
radiation-induced fibrotic changes
that affect lymphatic vessels. In any
case, regional lymphatic drainage is
reduced, leading to lymphatic fluid
accumulation and regional swelling.
296
Physical Therapy
Volume 89
Such swelling compromises the integument by increasing the likelihood of inflammation, infection, skin
breakdown, limits in joint ROM, and
decreased ability to move the affected limb. Lymphedema may be
most associated with surgical resection of the breast and surrounding
lymph nodes; however, surgical resection of a variety of tumors, including head and neck, genitourinary,
and reproductive tumors, can result
in lymphedema. Localized swelling
is the most common impairment of
lymphedema; therefore, measures
of this impairment focus on quantifying limb volume (Tab. 1, Immunological Systems Functions). The water displacement method is a highly
reliable method for determining the
volume of an extremity with lymphedema.117119 However, this method
requires specific equipment and
precise methods to obtain reliable
measurements. Methods using lightemitting diodes to calculate limb volume have shown early evidence in
detecting subclinical lymphedema,
allowing for early intervention and
prevention of symptomatic lymphedema.120 Volume estimates made
by a truncated cone formula using
several limb circumference measures
correlate highly with those determined by water displacement.117,118
Limb circumference measurements
may be more practical for some clinicians, given its simplicity and minimal equipment requirements. An
important component to early detection is the timing of volume measurements. It has been shown that preoperative measurements assist with
early detection and successful treatment of lymphedema.120
Volume measures are only one
method used to describe the severity
of lymphatic impairments. The National Cancer Institutes Common
Terminology Criteria for Adverse
Events, version 3,121 has expanded
the number of scales to grade the
severity of lymphatic and integu-
Number 3
mentary toxicity (ICF subdomain

skin and related structures). There
are separate scales for volume of
lymphedema in extremities, trunk
and genital region, head and neck,
and viscera. In addition, there are
scales to grade the severity of skin
color changes, lymph leakage, lymphocele, fibrosis, and phlebolymphatic cording.121 A weakness of
these scales is that the categories
are broad and, therefore, not sensitive to small differences that may be
clinically important. However, they
do provide standardization of language to describe changes to lymphatic tissues and integumentary
that may be clinically useful, particularly for long-term goals and clear communication among colleagues.
Diagnostic Measures of
Body Function and
Structure Indicating Red
Flags or Yellow Flags for
Physical Therapists
Body function and structure impairments identified through diagnostic
tests performed by a physician may
have significant implications for the
examination by a physical therapist
and the physical therapy plan of care
(Tab. 2). Conversely, the therapist
may identify concerning red flags
or yellow flags during the examination that would warrant recommending that the patient return to
his or her physician for further diagnostic testing. Both situations affect
patient safety and, therefore, are described below and in Table 2.
Some tumors cause neural impairment by compressing or infiltrating a
peripheral nerve, nerve plexus, or a
nerve tract or nucleus within the
central nervous system. The impairment may be sensory, motor, or autonomic, depending on the location,
size, and structure of the tumor.
Physical therapists must consider
common neurological sites at increased risk for tumor compression.
March 2009

For example, breast and lung tumors
can compress the brachial plexus,
and the lumbosacral plexus is sometimes affected by colorectal tumors,
gynecologic tumors, sarcomas, and
lymphomas.122 Regardless of the site,
the cardinal sign of neural compression is unrelenting pain, particularly
at night and later focal sensory disturbances or weakness in the distribution of the plexus or spinal cord
segment involved.122,123 These signs
and symptoms are particularly important to consider in patients with a
history of cancer who may enter the
clinic with a seemingly unrelated
musculoskeletal problem. If neural
compression from a tumor is suspected, the therapist needs to refer
the patient back to the primary physician so that further medical tests,
such as magnetic resonance imaging,
and appropriate treatment may be
performed.
Skeletal impairments often accompany a cancer diagnosis and reflect a
disease-associated loss of bony material (lytic tumor) or invasion of bone
(sclerotic tumor) by a primary or secondary tumor. Communication with
the medical team can help therapists navigate through the many risks
associated with tumor invasion of
skeletal structures. It is advantageous
for therapists to be familiar with
common patterns of cancer-related
skeletal system involvement (eg,
prostate, breast, lung, and colon
cancer often metastasize to the
spine; sarcomas commonly present
in the femur). As the tumor invades
the normal structure of bone, there
is reduced bone strength and increased risk of pathological fracture.124 Although there are no definitive guidelines to predict pathologic
fracture risk, it is helpful to monitor
the amount of cortex that has been
disrupted by tumor growth in long
bones used for functional tasks (eg,
the femur for gait, the humerus if
an assistive device is being used).
This can be calculated by a radioloMarch 2009
gist, using advanced imaging techniques. Table 2 summarizes specific

weight-bearing guidelines. Tumor
invasion of the vertebrae also can
affect the physical therapy plan of
care. If the tumor invades the vertebral arch, the segment may become unstable and possibly compress the spinal cord or adjacent
nerve roots, creating a medical emergency. Unrelenting back pain often
is the primary or presenting symptom of these lesions, and if a therapist suspects neurologic involvement, a segmental motor, sensory,
and autonomic examination should
be performed.123 If neural impingement is suspected, the medical team
should be notified immediately.125
Osteonecrosis and reduced bone
mineral density are common among
patients with cancer. Both cancer
and cancer treatments increase the
risk for developing osteonecrosis in
a variety of locations, including
proximal or distal femur, proximal
humerus, jaw, and metatarsals.126,127
New-onset pain and decreased
weight-bearing ability should alert
therapists to the possibility of osteonecrosis; however, this condition is
not always symptomatic.128 Pharmaceutical therapies (eg, corticosteroids, hormonal therapies, androgen
therapy) and radiation are associated
with reduced bone mineral density.68 70 Therefore, dual-energy x-ray
absorptiometry or computed tomography test results can alert therapists
to this problem and allow for appropriate intervention planning.
Tests such as a complete blood
count can help physical therapists
determine safe exercise guidelines,
particularly for patients who are undergoing or have just completed chemotherapy, radiation therapy, or
bone marrow transplant.129,130 Each
medical center or rehabilitation department has its own criteria for exercise prescription. These values often are the same as those used for
the general acute care population,

asto our best knowledgethere
are no evidence-based recommendations specific for patients with cancer.129,130 In addition to checking for
anemia, patients not tolerating aerobic exercise should be screened for
current or past use of cardiotoxic or
pneumotoxic chemotherapy medications and referred as appropriate
for further testing (see cardiovascular and respiratory discussion above).
Patients should avoid exposure to
infectious pathogens while neutropenic (eg, avoid public gyms, health
caregivers should avoid patient contact if they are ill). If the patient
is thrombocytopenic, high-impact
activities or contact sports should
be avoided to prevent excessive
bleeding.
Measurement of Activity
and Participation
The activity and participation domains encompass the ability to execute tasks, such as walking or bathing (activity), and the ability to
participate in life situations, such as
regularly attending work or school
and conducting interpersonal relationships (participation). The subdomains for activity and participation
(such as mobility and domestic life)
are given in a single list in the Figure,
with each component being able to
denote activity, participation, or
both.24 This flexibility allows for individual tailoring and operational differentiation of activity and participation.28,131,132 The ICF beginners
guide suggests that clinicians, researchers, and policymakers may
use this single list for their needs
and purposes to A) designate some
domains as Activities and others as
Participation and not allow overlap; B) make this designation but allow overlap in particular cases; C)
designate detailed (third- or fourthlevel) categories within a domain as
Activities and broad (second-level)
categories in the domain as Participation; or D) designate all domains
Volume 89
Number 3
Physical Therapy f
297

as potentially both Activity and
Participation.24(p127) Impairments in
body function and structure discussed in the previous sections can
result in changes at both the activity
and participation levels. Therefore,
assessing change in these constructs
is important.
Physical therapists typically select
primary outcome measures at the activity and participation levels when
their intervention plan as a whole is
directed toward improving a persons physical capacity or performance. Individually tailored rehabilitation goals, commonly seen in
physical therapy, take into account
personal and environmental factors
unique to the patient; however, the
use of standardized measures allows
for the comparison of individual activity and participation performance
to what might be expected from
control or population-specific values. The ability to make such comparisons may assist the therapist in
gauging patient progress during the
course of rehabilitation.
Important activity and participation
domains typically addressed by physical therapy interventions include:
(1) mobility, for example changing
and maintaining a body position,
carrying objects, or walking and
moving around; (2) self-care, such
as dressing, bathing, and toileting;
(3) domestic life (eg, carrying a
child, doing dishes); and (4) major
life areas such as the ability of a child
to access a classroom or the ability of
an adult to perform specific tasks related to paid employment (Tab. 3).
Currently available measures of activity and participation are rarely limited to a specific subdomain, and
most instruments include portions of
multiple constructs (eg, mobility and
self-care).131
Measuring activity limitations and
participation restrictions can be
done by timed or clinician-observed
298
Physical Therapy
Volume 89
evaluation or by patient self-report.

For example, the Functional Mobility
Assessment requires patients to
physically perform specific tasks and
to answer questions, quantifying
their level of function.133 In contrast,
the Toronto Extremity Salvage Score,
lower-extremity version, is a selfadministered questionnaire that asks
patients to indicate the level of difficulty they experience in dressing,
grooming, mobility, work, sports,
and leisure.134,135 Both methods of
measurement have different positive
attributes. In using quantitative measurement of limitations or restrictions, a therapist removes some of
the potential influences of symptom
distress or cognitive changes.136
However, the therapist must take
into account that performance-based
measures are effort dependent and
require that the activity be done in a
standard way. Severe cognitive problems may make a performance-based
measure difficult or impossible to
do. Qualitative measures also are
important, as patient-reported outcomes reflect the patients own perspective on his or her limitations
and restrictions. Additionally, some
symptoms, such as pain, can be measured only by self-report. By adding
the patients perspective, we can
better document the perceived burden of cancer and meaningful impact
of interventions.137
Mobility
The mobility subdomain includes
the following constructs: changing
and maintaining body positions; carrying, moving, and handling objects;
walking and moving; and moving
around using transportation. We will
discuss the changing and maintaining body positions and walking and
moving constructs, as they are assessed most commonly by physical
therapists.
ring between surfaces. Because the

balance deficits discussed in the body
function and structure section lead to
impaired ability to change and maintain body positions, this is a critical
area to explore in this population. Several appropriate activity-based measures of maintaining and changing
body positions, including those that
relate to balance impairments, are
described in Table 3.
The concepts of transferring between surfaces and walking and
moving often are combined in rehabilitation outcome measures, although they are separate categories
in the ICF model. A few examples of
combined transfer and mobility status measures include the Timed Up
& Go Test and the L Test of Functional Mobility (Tab. 3).
Self-care
The ability to care for ones self is a
construct often measured in rehabilitation settings. A few commonly reported measures are listed in Table 3
(Self-care). The Karnofsky Performance Scale138 has been a gold standard measure of overall performance
status in cancer treatment trials. In its
mid-range values, scores indicate the
ability of a person to perform self-care.
Because of its limited scope, some
authors139,140 have reported that it is
potentially limited in its responsiveness, a factor that may make it less
useful for measuring rehabilitation
outcomes. Other measures, such as
the Barthel Index,141 have multiple
components, including large representations of self-care activities in their
content, and are likely to be more responsive to changes seen with rehabilitation. Although these scales are used
often in inpatient rehabilitation research, they have relevance for oncology populations that may or may not
be seen in such a setting.
Changing and maintaining body positions incorporates both the concepts

of maintaining balance and transfer-
Number 3
March 2009

Table 3.
Measurement of Activity and Participation, With International Classification of Functioning, Disability and Health (ICF) Code
(Alphabetic Chapter and Numeric Second-Level Domains) in Parentheses
Construct
Mobilitychanging and maintaining
body positions (d410d429)
Mobilitywalking and moving

(d450d469)
Mobilitydevelopmental
(d410d469)
Measurement Tool
in Populations of
Patients With Cancer
5-time sit-to-stand
transitional movement ability224
None
Functional reach
Performance-based measure of balance

during voluntary movement in
standing225
Palliative care226
Berg Balance Scale
Performance-based, standardized
measure of static and dynamic
balance227,228
None
Dynamic Gait Index
Standardized performance-based
assessment of gait characteristics229,230
Vestibular schwannoma102
Standard Romberg Test and

Tandem Romberg Test
Standardized performance-based
assessment of static balance in various
positions229
Breast cancer104
Tinetti Balance and Gait

Scale
Simple and easily administered

performance test that quantifies gait
and balance characteristics. Scored on
patient performance of gait- and
balance-specific tasks.231
Lymphoma185
Timed Up & Go Test
A timed measure of balance and

mobility232
Leukemia,178,182,233
lymphoma,185
sarcoma,207,234
breast cancer79
L Test of Functional
Mobility
A performance-based assessment of basic

mobility skills, including walking,
transferring, and turning234
Lower-extremity solid
tumor234
Functional Mobility
Assessment
An instrument that combines assessment

of a patients physical performance
with self-report assessment of pain,
function, supports, satisfaction,
participation, and endurance133
Lower-extremity
sarcoma133
Toronto Extremity Salvage

Scale
A questionnaire that measures the level of

difficulty experienced by patients with
upper- and lower-extremity sarcoma in
performing everyday activities135
Sarcoma134,235,236
Fullerton Advanced Balance

Scale
Standardized performance-based clinical

test of gait and balance
characteristics237
Breast cancer104
Bruininks-Oseretsky Test of
Motor Proficiency
A performance-based measure of gross

and fine motor skills in children
41214 years of age (second edition:
41221 years of age)238
Leukemia239
Gross Motor Function

Measure
Performance/observation-based measure
of movement in children240
Leukemia239
Peabody Developmental
Motor Scale
Performance-based measure of motor

development in children aged 038
months with gross and fine motor
scales241
Leukemia,242 children with

cancer243
(Continued)
March 2009
Volume 89
Number 3
Physical Therapy f
299

Table 3.
Continued
Measurement Toola
Construct
Self-care (d510d599)
Domestic life, interpersonal relations,

and major life areas (d710d799)
in Populations of
Patients With Cancer
Barthel Index
Performance or self-report measure of

independence in basic activities of daily
living141
Prostate cancer,244
hospice,245,246
brain tumor247
Physical Performance Test
A 9-item timed test that simulates daily

activities248
None
Functional Independence
Measure
Provides estimate of burden of care based

on level of dependence in
performing basic activities of daily
living52
Solid tumor,249
brain tumor250
Karnofsky Performance
Scale
A standard measure of the ability of adult

patients with cancer to perform
ordinary tasks. The Karnofsky
Performance Scale scores range from 0
to 100. A higher score means the
patient is better able to carry out daily
activities.251
Most drug clinical trials

for all types of cancers
General Sickness Impact

Profile
A 136-item questionnaire that measures

the effect of sickness on everyday
activities and behaviors in adults252
General253
Reintegration to Normal
Living Index
An 11-item questionnaire covering

mobility, self-care, family roles, family
roles and personal relationships,
presentation of self, coping skills, work,
housework, and recreational and social
activities for adults145
Sarcoma146,235
Not intended to be an all inclusive list of measures, but as examples of measures that have been used in the oncology literature.
Domestic Life, Interpersonal

Relations, and Major Life Areas
Few measures typically used by
physical therapists attempt to quantify the capacity of a person to live as
a family member and as a member of
society (Tab. 3). Restrictions in the
ability of an individual to interact
with the environment or participate
fully in life situations increase the
disease burden on the individual, the
family, and society. Indeed, people
with participation restrictions are
more likely to report poor health142
and bouts of depression.143 It is generally recognized that patients and
survivors of cancer have restrictions
in these domains,144 yet there is a
paucity of outcome measures targeted here.
A measurement tool that is focused
specifically on the return to lifes
roles after a major health change is
300
Physical Therapy
Volume 89
the Reintegration to Normal Living

Index.145 This tool measures adults
perception of their ability to resume
their life roles after a serious illness
or trauma. It has been used sparingly
in populations of people with cancer.146,147 Because performance of
activities and participation in life
roles often are the main goals of rehabilitation, measurement of pertinent activity and participation subdomains provides useful information
regarding the need for and effectiveness of oncology rehabilitation.
Conclusion
This article uses the ICF model to
describe outcome measures that allow for broad quantification of
global function and methods to document progression in patients with
cancer and survivors of cancer. Understanding and documenting how
these structural or anatomic deficits
Number 3
restrict activities (grooming, dressing, child care) and participation (attending community activities, reduced job expectations) provide a
broader view of the patients abilities. Therapists need to be adept at
understanding the intended focus of
their therapeutic interventions and
using the most appropriate tools to
assess the effectiveness of those
interventions.
All authors provided concept/idea/project
design and writing. Dr Gilchrist and Dr Galantino provided project management. Dr
Ness provided consultation (including review of manuscript before submission).
As the Research Committee of the Oncology
Section of the American Physical Therapy
Association, the authors thank the Oncology
Section for their assistance and support in
the development of the manuscript.
March 2009

This article was received October 10, 2007,
and was accepted November 26, 2008.
DOI: 10.2522/ptj.20070309
References
1 Ries L, Melbert D, Krapcho M, et al. SEER
Cancer Statistics Review, 19752005.
Available at: http://seer.cancer.gov/csr/
1975_2005/. Accessed July 1, 2008,
based on November 2007 SEER data submission, posted to the SEER Web site,
2008.
2 US Cancer Statistics Working Group.
United States Cancer Statistics: 1999
2004. Incidence and mortality Webbased report. Available at: www.cdc.
gov/uscs. Accessed November 26, 2008.
3 Robison LL. Cancer survivorship: unique
opportunities for research. Cancer Epidemiol Biomarkers Prev. 2004;13:1093.
4 Merchant TE. Current management of
childhood ependymoma. Oncology (Willison Park). 2002;16:629 642, 644; discussion 645 646, 648.
5 van den Berg H. Biology and therapy of
malignant solid tumors in childhood.
Cancer Chemother Biol Response Modif.
2003;21:683707.
6 Sklar CA. Childhood brain tumors. J Pediatr Endocrinol Metab. 2002;15:669 673.
7 Freeman CR, Taylor RE, Kortmann RD,
Carrie C. Radiotherapy for medulloblastoma in children: a perspective on current international clinical research efforts. Med Pediatr Oncol. 2002;39:
99 108.
8 Habrand JL, De Crevoisier R. Radiation
therapy in the management of childhood
brain tumors. Childs Nerv Syst. 2001;
17:121133.
9 Kalapurakal JA, Dome JS, Perlman EJ,
et al. Management of Wilms tumour:
current practice and future goals. Lancet
Oncol. 2004;5:37 46.
10 Schwartz CL. Health status of childhood
cancer survivors: cure is more than the
eradication of cancer. JAMA. 2003;290:
16411643.
11 Schwartz CL. The management of
Hodgkin disease in the young child. Curr
Opin Pediatr. 2003;15:10 16.
12 Alcoser PW, Rodgers C. Treatment strategies in childhood cancer. J Pediatr
Nurs. 2003;18:103112.
13 Rao BN, Rodriguez-Galindo C. Local control in childhood extremity sarcomas: salvaging limbs and sparing function. Med
Pediatr Oncol. 2003;41:584 587.
14 Meyer WH, Spunt SL. Soft tissue sarcomas of childhood. Cancer Treat Rev.
2004;30:269 280.
15 Rutqvist LE, Rose C, Cavallin-Stahl E. A
systematic overview of radiation therapy
effects in breast cancer. Acta Oncol.
2003;42:532545.
16 Yeh E. Cardiotoxicity induced by chemotherapy and antibody therapy. Ann Rev
Med. 2006:485 498.
March 2009
17 Sklar CA, LaQuaglia MP. The long-term

complications of chemotherapy in childhood genitourinary tumors. Urol Clin
North Am. 2000;27:563568.
18 Marina N. Long-term survivors of childhood cancer: the medical consequences
of cure. Pediatr Clin North Am. 1997;
44:10211042.
19 Dieckmann K, Widder J, Potter R. Longterm side effects of radiotherapy in survivors of childhood cancer. Front Radiat
Ther Oncol. 2002;37:57 68.
20 Oeffinger KC, Mertens AC, Sklar CA,
et al. Chronic health conditions in adult
survivors of childhood cancer. N Engl
J Med. 2006;355:15721582.
21 Lee JQ, Simmonds MJ, Wang XS, Novy
DM. Differences in physical performance
between men and women with and without lymphoma. Arch Phys Med Rehabil.
2003;84:17471752.
22 Oeffinger KC, Mertens AC, Hudson MM,
et al. Health care of young adult survivors
of childhood cancer: a report from the
Childhood Cancer Survivor Study. Ann
Fam Med. 2004;2:6170.
23 Oeffinger KC, Eshelman DA, Tomlinson
GE, et al. Providing primary care for longterm survivors of childhood acute lymphoblastic leukemia. J Fam Pract.
2000;49:11331146.
24 International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
25 American Physical Therapy Association.
APTA Endorses ICF Model. PT Bulletin.
Vol 9, issue 26, 2008. Available at: http://
www.apta.org/AM/Template.cfm?Section
Archives2&Template / Customsource/
TaggedPage / PTIssue.cfm&Issue06 / 17 /
2008#article49312.
26 Nagi S. A study in the evaluation of disability and rehabilitation potential: concepts, methods, and procedures. Am J
Public Health Nations Health. 1964;54:
1568 1579.
27 Nagi S. Some Conceptual Issues in Disability and Rehabilitation. Washington,
DC: American Sociological Association;
1965.
28 Jette AM. Toward a common language
for function, disability, and health. Phys
Ther. 2006;86:726 734.
29 Nagi SZ. An epidemiology of disability
among adults in the United States. Milbank Mem Fund Q Health Soc. 1976;
54:439 467.
30 Nagi SZ. Congruency in medical and selfassessment of disability. IMS Ind Med
Surg. 1969;38:2736.
31 Quasthoff S, Hartung HP. Chemotherapyinduced peripheral neuropathy. J Neurol. 2002;249:9 17.
32 Kesselring J, Coenen M, Cieza A, et al.
Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult
Scler. 2008;14:252254.
33 Geyh S, Cieza A, Schouten J, et al. ICF
Core Sets for stroke. J Rehabil Med.
2004:135141.
34 Starrost K, Geyh S, Trautwein A, et al.

Interrater reliability of the extended ICF
Core Set for stroke applied by physical
therapists. Phys Ther. 2008;88:841 851.
35 Dreinhofer K, Stucki G, Ewert T, et al.
ICF Core Sets for osteoarthritis. J Rehabil
Med. 2004:75 80.
36 Ruof J, Cieza A, Wolff B, et al. ICF Core
Sets for diabetes mellitus. J Rehabil Med.
2004:100 106.
37 Cieza A, Stucki G, Weigl M, et al. ICF
Core Sets for low back pain. J Rehabil
Med. 2004:69 74.
38 Stucki A, Daansen P, Fuessl M, et al. ICF
Core Sets for obesity. J Rehabil Med.
2004:107113.
39 Cieza A, Schwarzkopf S, Sigl T, et al. ICF
Core Sets for osteoporosis. J Rehabil
Med. 2004:81 86.
40 Kirchberger I, Glaessel A, Stucki G, Cieza
A. Validation of the comprehensive International Classification of Functioning, Disability and Health Core Set for
rheumatoid arthritis: the perspective of
physical
therapists.
Phys
Ther.
2007;87:368 384.
41 Uhlig T, Lillemo S, Moe RH, et al. Reliability of the ICF Core Set for rheumatoid arthritis. Ann Rheum Dis. 2007;66:
1078 1084.
42 Stamm T, Geyh S, Cieza A, et al. Measuring functioning in patients with hand osteoarthritis: content comparison of questionnaires based on the International
Classification of Functioning, Disability
and Health (ICF). Rheumatology (Oxford). 2006;45:1534 1541.
43 Stucki A, Borchers M, Stucki G, et al.
Content comparison of health status
measures for obesity based on the International Classification of Functioning,
Disability and Health. Int J Obes
(Lond). 2006;30:17911799.
44 Sigl T, Cieza A, Brockow T, et al. Content
comparison of low back pain-specific
measures based on the International
and Health (ICF). Clin J Pain.
2006;22:147153.
45 Borchers M, Cieza A, Sigl T, et al. Content
comparison of osteoporosis-targeted
health status measures in relation to the
International Classification of Functioning, Disability and Health (ICF).
Clin Rheumatol. 2005;24:139 144.
46 Cieza A, Geyh S, Chatterji S, et al. ICF
linking rules: an update based on lessons learned. J Rehabil Med. 2005;37:
212218.
47 Tschiesner U, Cieza A, Rogers SN, et al.
Developing core sets for patients with
head and neck cancer based on the International Classification of Functioning, Disability and Health (ICF). Eur
Arch
Otorhinolaryngol.
2007;264:
12151222.
48 Brach M, Cieza A, Stucki G, et al. ICF
Core Sets for breast cancer. J Rehabil
Med. 2004:121127.
Volume 89
Number 3
Physical Therapy f
301

49 Stucki G, Melvin J. The International
and Health: a unifying model for the
conceptual description of physical and
rehabilitation medicine. J Rehabil Med.
2007;39:286 292.
50 Finger ME, Cieza A, Stoll J, et al. Identification of intervention categories for
physical therapy, based on the International Classification of Functioning,
Disability and Health: a Delphi exercise.
Phys Ther. 2006;86:12031220.
51 Roach K. Measurement of health outcomes:reliability, validity and responsiveness. J Prosth Orthot. 2006;18:8 12.
52 Keith R, Granger C, Hamilton B, Sherwin
F. The Functional Independence Measure: a new tool for rehabilitation. In:
Eisenberg M, Grzesiak R, eds. Advances
in Clinical Rehabilitation. New York,
NY: Springer Publishing Co; 1987:6 18.
53 Portney L, Watkins M. Foundations of
Clinical Research Applications to Practice. 2nd ed. Upper Saddle River, NJ:
Prentice Hall Health; 2000.
54 Ahles T, Saykin A. Breast cancer
chemotherapy-related cognitive dysfunction. Clin Breast Cancer. 2002;3:
S84 S90.
55 Barton D, Loprinizi C. Novel approaches
to preventing chemotherapy-induced
cognitive dysfunction in breast cancer:
the art of the possible. Clin Breast Cancer. 2002;3:S121S127.
56 Castellon S, Ganz P, Bower J, et al. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp
Neuropsychol. 2004;26:955969.
57 Dam FV, Schagen S, Muller M, et al. Impairment of cognitive function in women
receiving adjuvant treatment for highrisk breast cancer: high-dose versus
standard-dose chemotherapy. J Nat Cancer Inst. 1998;90:210 218.
58 Freeman J, Broshek D. Assessing cognitive dysfunction in breast cancer: What
are the tools? Clin Breast Cancer Suppl.
2002;3:9199.
59 Olin J. Cognitive function after systemic
therapy for breast cancer. Oncology.
2001;15:613 618.
60 Rugo H, Ahles T. The impact of adjuvant
therapy for breast cancer on cognitive
function: current evidence and directions for research. Semin Oncol. 2003;
30:749 762.
61 Schagen S, Van Dam F, Muller M, et al.
Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer. 1999;85:640 650.
62 Stewart A, Bielajew C, Collins B, et al. A
meta-analysis of the neuropsychological
effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clin Neuropsychol. 2006;20:76 89.
63 Tchen N, Juffs H, Downie F, et al. Cognitive function, fatigue, and menopausal
symptoms in women receiving adjuvant
chemotherapy for breast cancer. J Clin
Oncol. 2003;21:4175 4183.
302
Physical Therapy
Volume 89
64 Wefel J, Lenxi R, Theriault R, et al. The

cognitive sequelae of standard-dose adjuvant chemotherapy in women with
breast carcinoma: results of a prospective, randomized, longitudinal trial. Cancer. 2004;100:22922299.
65 Wieneke M, Dienst E. Neuropsychological assessment of cognitive functioning
following chemotherapy for breast cancer. Psycho-oncology. 1995;4:61 66.
66 Paganini-Hill A, Clark L. Preliminary assessment of cognitive function in breast
cancer patients treated with tamoxifen.
Breast Cancer Res Treat. 2000;64:
165176.
67 Ahles T, Saykin A, Furstenberg C, et al.
Neuropsychologic impact of standarddose systemic chemotherapy in longterm survivors of breast cancer and lymphoma. J Clin Oncol. 2002;20:485 493.
68 OShaughnessy J. Chemotherapy-related
cognitive dysfunction in breast cancer.
Semin Oncol Nurs. 2003;19:1724.
69 OShaughnessy J. Chemotherapy-related
cognitive dysfunction: a clearer picture.
Clin Breast Cancer. 2003;4(suppl 2):
S89 S84.
70 Folstein M, Folstein S, McHugh P. MiniMental State: a practical method for grading the state of patients for the clinician
J Psychiatr Res. 1975;12:189 198.
71 Jansen C, Miaskowski C, Dodd M, Dowling G. A meta-analysis of the sensitivity
of various neuropsychological tests uses
to detect chemotherapay-induced cognitive impairment in patients with breast
cancer. Oncol Nurs Forum. 2007;34:
9971005.
72 Cella D, Tross S, Orov E, et al. Mood states
of patients after the diagnosis of cancer.
J Psychosoc Oncol. 1989;7:4553.
73 McNair D, Loor M, Droppleman L. Profile
of Mood States. San Diego, CA: Educational and Industrial Testing Service;
1971.
74 Sergi B, Ferraresi A, Troiani D, et al. Cisplatin ototoxicity in the guinea pig: vestibular and cochlear damage. Hear Res.
2003;182:56 64.
75 FDA-Approved Label for Cisplatin. 2007.
Available at: http://www.fda.gov/cder/
ogd/rld/18057s68.pdf. Accessed November 26, 2008.
76 Verstappen CCP, Heimans JJ, Hoekman
K, Postma TJ. Neurotoxic complications
of chemotherapy in patients with cancer.
Drugs. 2003;63:1549 1563.
77 Chaudhry V, Rowinsky EK, Sartorius SE,
et al. Peripheral neuropathy from taxol
and cisplatin combination chemotherapy: clinical and electrophysiological studies. Ann Neurol. 1994;35:304 311.
78 Cavaletti G, Jann S, Pace A, et al. Multicenter assessment of the Total Neuropathy Score for chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv
Syst. 2006;11:135141.
79 Wampler M, Miaskowski C, Hamel K,
et al. The modified Total Neuropathy
Score: a clinically feasible and valid measure of taxane-induced peripheral neuropathy in women with breast cancer.
J Support Oncol. 2006;4:397 402.
Number 3
80 Chaudhry V, Chaudhry M, Crawford TO,

et al. Toxic neuropathy in patients with
pre-existing neuropathy. Neurology.
2003;60:337340.
81 Cavaletti G, Bogliun G, Marzorati L, et al.
Grading of chemotherapy-induced peripheral neurotoxicity using the Total
Neuropathy Scale. Neurology. 2003;61:
12971300.
82 Stevens P, Dibble S, Miaskowski C. Prevalence, characteristics, and impact of
postmastectomy pain syndrome: an investigation of womens experiences.
Pain. 1995;61:61 68.
83 Galecki J, Hicer-Grzenkowicz J, GrudzienKowalska M, et al. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients
with breast cancer: a review. Acta Oncol.
2006;45:280 284.
84 Cherny N. The management of cancer
pain. CA Cancer J Clin. 2000;50:70 116.
85 Serlin R, Mendoza T, Nakamura Y, et al.
When is cancer pain mild, moderate or
severe? Grading pain severity by its interference with function. Pain. 1995;61:
277284.
86 Jensen M, Karoly P, Braver S. The measurement of clinical pain intensity: a
comparison of six methods. Pain.
1986;27:117126.
87 Jensen M, Turner J, Romano J, Fisher L.
Comparative reliability and validity of
chronic pain intensity measures. Pain.
1999;83:157162.
88 Cleeland C. Measurement and prevalence of pain in cancer. Semin Oncol
Nurs. 1985;1:8792.
89 Evans C, Trudeau E, Mertzanis P, et al.
Development and validation of the Pain
Treatment Satisfaction Scale (PTSS): a patient satisfaction questionnaire for use in
patients with chronic or acute pain.
Pain. 2004;112:254 266.
90 Rietman JS, Dijkstra PU, Geertzen JH,
et al. Short-term morbidity of the upper
limb after sentinel lymph node biopsy or
axillary lymph node dissection for stage I
or II breast carcinoma. Cancer. 2003;
98:690 696.
91 Blomqvist L, Stark B, Engler N, Malm M.
Evaluation of arm and shoulder mobility
and strength after modified radical mastectomy and radiotherapy. Acta Oncol.
2004;43:280 283.
92 Dijkstra PU, van Wilgen PC, Buijs RP,
et al. Incidence of shoulder pain after
neck dissection: a clinical explorative
study for risk factors. Head Neck. 2001;
23:947953.
93 Erisen L, Basel B, Irdesel J, et al. Shoulder
function after accessory nerve-sparing
neck
dissections.
Head
Neck.
2004;26:967971.
94 Guldiken Y, Orhan KS, Demirel T, et al.
Assessment of shoulder impairment after functional neck dissection: long term
results. Auris Nasus Larynx. 2005;32:
387391.
95 Inui A. Cancer anorexia-cachexia syndrome: current issues in research and
management. CA Cancer J Clin. 2002;
52:7291.
March 2009

96 Owczarek J, Jasinska M, OrszulakMichalak D. Drug-induced myopathies:
an overview of possible mechanisms.
Pharmacol Rep. 2005;57:2334.
97 Mathiowetz V, Kashman N, Volland G,
et al. Grip and pinch strength: normative
data for adults. Arch Phys Med Rehabil.
1985;66:69 72.
98 Bohannon RW. Reference values for extremity muscle strength obtained by
hand-held dynamometry from adults
aged 20 to 79 years. Arch Phys Med Rehabil. 1997;78:26 32.
99 Ochs BG, Simank HG, Kopp-Schneider A,
et al. Gait analysis in limb preserving tumour surgery: kinematic gait patterns after resection of malignant bone tumours
near the knee joint. Z Orthop Unfall.
2007;145:763771.
100 Benedetti MG, Catani F, Donati D, et al.
Muscle performance about the knee joint
in patients who had distal femoral replacement after resection of a bone tumor: an objective study with use of gait
analysis. J Bone Joint Surg Am. 2000;
82:1619 1625.
101 Gerber L, Hoffman K, Chaudry U, et al.
Functional outcomes and life satisfaction
in long-term survivors of pediatric sarcoma. Arch Phys Med Rehabil. 2006;
87:16111617.
102 Choy N, Johnson N, Treleaven J, et al.
Balance, mobility and gaze stability deficits remain following surgical removal of
vestibular schwannoma (acoustic neuroma): an observational study Aust J Physiother. 2006;52:211216.
103 Syczewska M, Dembowska-Baginska B,
Perek-Polnik M, Perek D. Functional status of children after treatment for a malignant tumor of the CNS: a preliminary
report. Gait Posture. 2006;23:206 210.
104 Wampler MA, Topp KS, Miaskowski C,
et al. Quantitative and clinical description of postural instability in women
with breast cancer treated with taxane
chemotherapy. Arch Phys Med Rehabil.
2007;88:10021008.
105 Holley S. A look at the problem of falls
among people with cancer. Clin J Oncol
Nurs. 2002;6:193197.
106 Camp-Sorrell D. Cardiorespiratory effects
in cancer survivors. Am J Nurs. 2006;
106:5559.
107 Floyd J, Nguyen D, Lobins R, et al. Cardiotoxicity of cancer therapy. J Clin Oncol. 2005;23:76857696.
108 Harris E, Correa C, Hwang W, et al. Late
cardiac mortality and morbidity in earlystage breast cancer patients after breast
conservation treatment. J Clin Oncol.
2006;24:4100 4106.
109 Limper A. Chemotherapy induced lung
disease. Clin Chest Med. 2004;25:53 64.
110 Butland R, Pang J, Gross E, et al. Two-,
six-, and twelve-minute walking tests in
respiratory disease. BMJ. 1982;284:
16071608.
111 Medical Research Council. Instructions
for Use of the Questionaire on Respiratory Symptoms. Dawlish, England: WJ
Holman; 1966.
March 2009
112 Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc.
1982;4:377381.
113 Dimeo F, Schmittel A, Fietz T, et al. Physical performance, depression, immune
status and fatigue in patients with hematological malignancies after treatment.
Ann Oncol. 2004;15:12371242.
114 Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in
adults. Cochrane Database Syst Rev. 2008:
CD006145.
115 Bruera E, Strasser F, Shen L, et al. The
effect of donepezil on sedation and other
symptoms in patients receiving opioids
for cancer pain: a pilot study. J Pain
Symptom Manage. 2003;26:1049 1054.
116 Mulrooney DA, Ness KK, Neglia JP, et al.
Fatigue and sleep disturbance in adult
survivors of childhood cancer: a report
from the Childhood Cancer Survivor
Study (CCSS). Sleep. 2008;31:271281.
117 Taylor R, Jayasinghe UW, Koelmeyer L,
et al. Reliability and validity of arm volume
measurements for assessment of lymphedema. Phys Ther. 2006;86:205214.
118 Karges JR, Mark BE, Stikeleather SJ, Worrell TW. Concurrent validity of upperextremity volume estimates: comparison
of calculated volume derived from girth
measurements and water displacement
volume. Phys Ther. 2003;83:134 145.
119 Megens AM, Harris SR, Kim-Sing C, McKenzie DC. Measurement of upper extremity volume in women after axillary
dissection for breast cancer. Arch Phys
Med Rehabil. 2001;82:1639 1644.
120 Stout-Gerich NL, Pfalzer LA, McGarvey C,
et al. Preoperative assessment enables
the early diagnosis and successful treatment of lymphedema. Cancer Invest.
2008;112:2809 2019.
121 Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0).
Available at: http://ctep.cancer.gov/
forms/CTCAEv3.pdf. Accessed March 14,
2007.
122 Jaeckle KA. Neurological manifestations
of neoplastic and radiation-induced
plexopathies. Semin Neurol. 2004;24:
385393.
123 Lowey SE. Spinal cord compression: an
oncologic emergency associated with
metastatic cancer: evaluation and management for the home health clinician.
Home Healthc Nurse. 2006;24:439 446.
124 Hipp J, Springfield D, Hayes W. Predicting pathologic fracture risk in the management of metastatic bone defects. Clin
Orthop Relat Res. 1995:120 135.
125 Rades D, Veninga T, Stalpers L, et al. Improved posttreatment functional outcomes is associated with better survival
in patients irradiated for metastatic spinal
cord compression. Int J Radiat Oncol
Biol Phys. 2007;67:1506 1509.
126 Majhail N, Ness K, Burns L, et al. Late
effects in survivors of Hodgkin and nonHodgkin lymphoma: a report from the
Bone Marrow Transplant Survivor Study.
Biol Blood Marrow Transplant. 2007;
13:11531159.
127 Friedrich R, Blake F. Avascular mandibular osteonecrosis in association with

bisphosphonate therapy: a report on four
patients. Anticancer Res. 2007;27:
18411845.
128 Marchese VG, Connolly B, Able C, et al.
Relationships among severity of osteonecrosis, pain, range of motion, and
functional mobility in children, adolescents, and young adults with acute lymphoblastic leukemia. Phys Ther. 2008;88:
341350.
129 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists. 4th ed.
St Louis, MO: Elsevier; 2007.
130 Piech D, Sanders B, Ghazinouri R, et al. Lab
values interpretation resources. Available
at: http://www.acutept.org/labvalues.pdf.
Accessed October 2, 2008.
131 Perenboom RJ, Chorus AM. Measuring
participation according to the International Classification of Functioning,
Disability and Health (ICF). Disability
Rehabil. 2003;25:577587.
132 Badley EM. Enhancing the conceptual
clarity of the activity and participation
components of the International Classification of Functioning, Disability and
Health. Soc Sci Med. 2008;66:23352345.
133 Marchese VG, Rai SN, Carlson CA, et al.
Assessing functional mobility in survivors
of lower-extremity sarcoma: reliability
and validity of a new assessment tool.
Pediatr Blood Cancer. 2007;49:183189.
134 Davis AM, Sennik S, Griffin AM, et al. Predictors of functional outcomes following
limb salvage surgery for lower-extremity
soft tissue sarcoma. J Surg Oncol.
2000;73:206 211.
135 Davis AM, Wright JG, Williams JI, et al.
Development of a measure of physical
function for patients with bone and soft
tissue sarcoma. Qual Life Res. 1996;5:
508 516.
136 Montoya M, Fossella F, Palmer J, et al.
Objective evaluation of physical function
in patients with advanced lung cancer: a
preliminary report. J Palliat Med. 2006;
9:309 316.
137 Lipscomb J, Gotay CC, Snyder CF.
Patient-reported outcomes in cancer: a
review of recent research and policy initiatives. CA Cancer J Clin. 2007;57:
278 300.
138 Hwang SC, Scot CB, Chang VT, et al. Predition of survival for advanced cancer patients by recursive portioning analysis:
role of Karnofsky performance status,
quality of life and symptom distress. Cancer Invest 2004;22:678 687.
139 Hassan SJ, Weymuller EA Jr. Assessments
of quality of life in head and neck cancer.
Head Neck. 1993;15:485 496.
140 Kassa T, Wessel J. The Edmonton Functional Assessment Tool: further development and validation for use in palliative
care. J Palliat Care. 2001;17:511.
141 Mahoney F, Barthel D. Functional evaluation: the Barthel Index. MD State Med J.
1965;14:61 65.
Volume 89
Number 3
Physical Therapy f
303

142 Larson S, Lakin K, Anderson L, et al. Prevalence of mental retardation and developmental disabilities: estimates from the
1994/1995 national health interview survey disability supplements. Am J Ment
Retard. 2001;106:231252.
143 Lenze E, Rogers J, Martire L, et al. The
association of late-life depression and
anxiety with physical disability: a review
of the literature and prospectus for future research. Am J Geriatr Psychiatry.
2001;9:113135.
144 Ness K, Mertens A, Hudson M, et al. Limitations on physical performance and
daily activities among long-term survivors of childhood cancer. Ann Int Med.
2006;143:639 647.
145 Wood-Dauphinee SL, Opzoomer M, Williams J, et al. Assessment of global function: the Reintegration to Normal Living
Index. Arch Phys Med Rehabil. 1988;
69:583590.
146 Schreiber D, Bell R, Wunder J, et al. Evaluating function and health-related quality
of life in patients treated for extremity
soft tissue sarcoma. Qual Life Res.
2006;15:1439 1446.
147 Tunn PU, Pomraenke D, Goerling U, Hohenberger P. Functional outcome after
endoprosthetic limb-salvage therapy of
primary bone tumours: a comparative
analysis using the MSTS score, the TESS
and the RNL index. Int Orthop. 2008;
32:619 625.
148 Faust D, Fogel BS. The development and
initial validation of a sensitive bedside
cognitive screening test. J Nerv Ment
Dis. 1989;177:2531.
149 Shilling V, Jenkins V. Impact of androgen
deprivation therapy on physical and cognitive function, as well as quality of life of
patients with nonmetastatic prostate cancer. J Urol. 2006;176:24432447.
150 Meyers CA, Wefel JS. The Use of the MiniMental State Examination to Assess Cognitive Functioning in Cancer Trials: No
Ifs, Ands, Buts, or Sensitivity. J Clin Oncol. 2003;21:35573558.
151 Jacobs SR, Jacobsen PB, Booth-Jones M,
et al. Evaluation of the Functional Assessment of Cancer Therapy Cognitive Scale
with hematopoetic stem cell transplant
patients. J Pain Symptom Manage.
2007;33:1323.
152 Galantino M, Brown D, Stricker C, Farrar
J. Development and testing of a cancer
cognition questionnaire. Rehab Oncol.
2006;24:1522.
153 Ahles T, Silberfarb P, Herndon Jn, et al.
Psychological adjustment of survivors of
localised prostate cancer: investigating
the role of dyadic adjustment, cognitive
appraisal and coping style. Psychooncology. 2007;16:994 1002.
154 Brown P, Clark M, Atherton P, et al. Will
improvement in quality of life (QOL) impact fatigue in patients receiving radiation therapy for advanced cancer? Am J
Clin Oncol. 2006;29:5258.
155 Hack T, Degner L. Coping responses following breast cancer diagnosis predict
psychological adjustment three years later. Psychooncology. 2004;13:235247.
304
Physical Therapy
Volume 89
156 Brezden C, Phillips K, Abdolell M, et al.

Cognitive function in breast cancer patients receiving adjuvant chemotherapy.
J Clin Oncol. 2000;18:26952701.
157 Ahles T, Silberfarb P, Herndon J, et al.
Psychologic and neuropsychologic functioning of patients with limited small-cell
lung cancer treated with chemotherapy
and radiation therapy with or without
warfarin: a study by the Cancer and Leukemia Group B. J Clin Oncol. 1998;
16:1954 1960.
158 Kurnatowski P, Putyn
ski L, Piotrowski S.
The evaluation of certain psychological
indices concerning cognitive and emotional behaviors in patients after radical
neck dissection. Otolaryngol Pol. 1997;
51:58 63.
159 Jacobson G, Newman C, Hunter L, Balzer
G. Balance function test correlates of the
Dizziness Handicap Inventory. J Am
Acad Audiol. 1991;2:253260.
160 Humphriss R, Baguley D, Moffat D.
Change in dizziness handicap after vestibular schwannoma excision. Otol Neurotol. 2003;24:661 665.
161 Enticott J, OLeary S, Briggs R. Effects of
vestibulo-ocular reflex exercises on vestibular compensation after vestibular
schwannoma surgery. Otol Neurotol.
2005;26:265269.
162 Roberts RA, Gans RE, Johnson EL,
Chisolm TH. Computerized dynamic visual acuity with volitional head movement in patients with vestibular dysfunction. Ann Otol Rhinol Laryngol. 2006;
115:658 666.
163 Goebel JA, Tungsiripat N, Sinks B, Carmody J. Gaze stabilization test: a new
clinical test of unilateral vestibular dysfunction. Otol Neurotol. 2007;28:68 73.
164 Shy ME, Frohman EM, So YT, et al. Quantitative sensory testing: report of the
Therapeutics and Technology Assessment Subcommittee of the American
Academy of Neurology. Neurology.
2003;60:898 904.
165 Bloom S, Till S, Sonksen P, Smith S. Use of
a biothesiometer to measure individual
vibration thresholds and their variation
in 519 non-diabetic subjects. Br Med J
(Clin Res Ed). 1984;288:17931795.
166 Scott J, Huskisson E. Graphic representation of pain. Pain. 1976;2:175184.
167 Camps C, Caballero C, Blasco A, et al.
Weekly paclitaxel as second/third-line
treatment in advanced non-small cell lung
cancer patients: efficacy and tolerability.
Anticancer Res. 2005;25:4611 4614.
168 Zernikow B, Meyerhoff U, Michel E, et al.
Pain in pediatric oncology: childrens
and parents perspectives. Eur J Pain.
2005;9:395 406.
169 Zernikow B, Smale H, Michel E, et al. Paediatric cancer pain management using
the WHO analgesic ladder: results of a
prospective analysis from 2,265 treatment days during a quality improvement
study. Eur J Pain. 2006;10:587595.
Number 3
170 Villars P, Dodd M, West C, et al. Differences in the prevalence and severity of
side effects based on type of analgesic
prescription in patients with chronic
cancer pain. J Pain Symptom Manage.
2007;33:6777.
171 Hicks C, von Bayer C, Spafford P, et al.
The faces pain scale-revised:toward a
common metric in pediatric pain measurement. Pain. 2001;93:173183.
172 Caraceni A, Portenoy R; a working group
of the IASP Task Force on Cancer Pain.
An international survey of cancer pain
characteristics and syndromes. Pain.
1999;82:263274.
173 Borden L, Clark P, Lovato J, et al. Vinorelbine, doxorubicin, and prednisone in
androgen-independent prostate cancer.
Cancer. 2006;107:10931100.
174 Miaskowski C, Dodd M, West C, et al.
The use of a responder analysis to identify differences in patient outcomes following a self-care intervention to improve cancer pain management. Pain.
2007;129:55 63.
175 Joint Motion: Method of Measuring and
Recording. Chicago, IL: American Academy of Orthopaedic Surgeons; 1965.
176 Reese N, Bandy W. Joint Range of Motion and Muscle Length Testing. Philadelphia, PA: WB Saunders Co; 2002.
177 Leidenius M, Leppanen E, Krogerus L,
von Smitten K. Motion restriction and
axillary web syndrome after sentinel
node biopsy and axillary clearance in
breast cancer. Am J Surg. 2003;185:
127130.
178 Marchese VG, Chiarello L. Relationships
between specific measures of body function, activity, and participation in children with acute lymphoblastic leukemia.
Rehabil Oncol. 2004;22:59.
179 Paulino A. Late effects of radiotherapy for
pediatric extremity sarcomas. Int J Rad
Oncol Biol Phys. 2004;60:265274.
180 Golding L, Myers C, Sinning W. Ys Way
to Physical Fitness. Champaign, IL: Human Kinetics Inc; 1989.
181 Kolden G, Straiam T, Ward A, et al. A
pilot study of group exercise training for
women with primary breast cancer: feasibility and health benefits. Psychooncology. 2006;11:447 456.
182 Ness KK, Baker KS, Dengel D, et al. Body
composition, muscle strength deficits
and mobility limitations in adult survivors
of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:
975981.
183 Hayes S, Battistutta D, Newman B. Objective and subjective upper body function
six months following diagnosis of breast
cancer. Breast Cancer Res Treat. 2005;
94:110.
184 Rietman J, Geertzen J, Hoekstra H, et al.
Long-term treatment-related upper limb
morbidity and quality of life after sentinal
lymph node biopsy for stage I or II breast
cancer. Eur J Surg Oncol. 2006;32:
148 152.
March 2009

185 Siegel AB, Lachs M, Coleman M, Leonard
JP. Lymphoma in elderly patients: novel
functional assessment techniques provide better discrimination among patients than traditional performance status
measures. Clin Lymphoma Myeloma.
2006;7:65 69.
186 Abu-Rustum N, Alektiar K, Iasonos A,
et al. The incidence of symptomatic
lower-extremity lymphedema following
treatment of uterine corpus malignancies: a 12-year experience at Memorial
Sloan-Kettering Cancer Center. Gynecol
Oncol. 2006;103:714 718.
187 Monsell EM, Furman JM, Herdman SJ,
et al. Computerized dynamic platform
posturography. Otolaryngol Head Neck
Surg. 1997;117:394 398.
188 Gouveris H, Akkafa S, Lippold R, Mann
W. Influence of nerve of origin and tumor size of vestibular schwannoma on
dynamic posturography findings. Acta
Otolaryngol. 2006;126:12811285.
189 Bergson E, Sataloff R. Preoperative computerized dynamic posturography as a
prognostic indicator of balance function
in patients with acoustic neuroma. Ear
Nose Throat J. 2005;84:154 156.
190 Galvao D, Nosaka K, Taaffe D, et al. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc. 2006;38:
20452052.
191 Konczak J, Schoch B, Dimitrova A, et al.
Functional recovery of children and adolescents after cerebellar tumour resection. Brain. 2005;128:1428 1441.
192 American College of Sports Medicine.
ACSMs Guidelines for Exercise Testing
and Prescription. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
193 de Miguel Sanchez C, Elustondo S, Estirado A, et al. Palliative performance status, heart rate and respiratory rate as predictive factors of survival time in
terminally ill cancer patients. J Pain
Symptom Manage. 2006;31:485 492.
194 Haddy T, Mosher R, Reaman G. Hypertension and pre-hypertension in longterm survivors of childhood and adolescent cancer. Pediatr Blood Cancer.
2007;49:79 83.
195 Kourti M, Tragiannidis A, Makedou A,
et al. Metabolic syndrome in children
and adolescents with acute lymphoblastic leukemia after the completion of chemotherapy. J Pediatr Hematol Oncol.
2005;27:499 501.
196 Sagstuen H, Aass N, Fossa S, et al. Blood
pressure and body mass index in longterm survivors of testicular cancer. J Clin
Oncol. 2005;23:4980 4990.
197 Pietila S, Ala-Houhala M, Lenko H, et al.
Renal impairment and hypertension in
brain tumor patients treated in childhood
are mainly associated with cisplatin treatment. Pediatr Blood Cancer. 2005;44:
363369.
198 Dudgeon D, Lertzman M, Askew G. Physiologic changes and clinical correlations
of dyspnea in cancer outpatients. J Pain
Symptom Manage. 2001;21:373379.
March 2009
199 Nomori H, Watanabe K, Ohtsuka T, et al.

Six-minute walk and pulmonary function
test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease. Jpn J Thorac
Cardiovasc Surg. 2004;52:113119.
200 Weiner D, Maity A, Carlson C, Ginsberg J.
Pulmonary function abnormalities in children treated with whole lung irradiation.
Pediatr Blood Cancer. 2006;46:222227.
201 Bossi G, Cerveri I, Volpini E, et al. Longterm pulmonary sequelae after treatment
of childhood Hodgkins disease. Ann Oncol. 1997;8:19 24.
202 Herrero F, San Juan A, Fleck S, et al. Effects of detraining on the functional capacity of previously trained breast cancer
survivors. Int J Sports Med. 2007;28:
257264.
203 Herrero F, San Juan A, Fleck S, et al. Combined aerobic and resistance training in
breast cancer survivors: a randomized,
controlled pilot trial. Int J Sports Med.
2006;27:573580.
204 Cheema B, Gaul C. Full-body exercise
training improves fitness and quality of
life in survivors of breast cancer.
J Strength Cond Res. 2006;20:14 21.
205 Hlatky M, Boineau R, Higginbotham M,
et al. A brief self-administered questionnaire to determine functional capacity
(the Duke Activity Status Index). Am J
Cardiol. 1989;64:651 654.
206 Health Related Physical Fitness: Test
Manual. Reston, VA: American Alliance
for Health, Physical Education, Recreation and Dance; 1980.
207 Marchese V, Ogle S, Womer R, et al. An
examination of outcome measures to
asess functional mobility in childhood
survivors of osteosarcoma. Pediatr Blood
Cancer. 2004;42:41 45.
208 Smets E, Garssen B, Bonke B, et al. The
Multidimensional Fatigue Inventory
(MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res.
1995;39:315325.
209 Jereczek-Fossa B, Santoro L, Alterio D,
et al. Fatigue during head-and-neck radiotherapy: prospective study on 117 consecutive patients. Int J Radiat Oncol Biol
Phys. 2007;68:403 415.
210 Yellen S, Cella D, Webster K, et al. Measuring fatigue and other anemia-related
symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13:6374.
211 Piper B, Dibble S, Dodd M, et al. The revised Piper Fatigue Scale: psychometric
evaluation in women with breast cancer.
Oncol Nurs Forum. 1998;25:677 684.
212 Meeske K, Siegel S, Globe D, et al. Prevalence and correlates of fatigue in longterm survivors of childhood leukemia.
J Clin Oncol. 2005;23:55015510.
213 Berger A, Farr L, Kuhn B, et al. Values of
sleep/wake,
activity/rest,
circadian
rhythms, and fatigue prior to adjuvant
breast cancer chemotherapy. J Pain
214 Mendoza T, Wang X, Cleeland C, et al.

The rapid assessment of fatigue severity
in cancer patients: use of the Brief Fatigue
Inventory. Cancer. 1999;85:1186 1196.
215 Wang X, Giralt S, Mendoza T, et al. Clinical factors associated with cancerrelated fatigue in patients being treated
for leukemia and non-Hodgkins lymphoma. J Clin Oncol. 2002;20:1319 1328.
216 Wang X, Janjan N, Guo H, et al. Fatigue
during preoperative chemoradiation for
resectable rectal cancer. Cancer. 2001;
92:17251732.
217 Stanton AW, Northfield JW, Holroyd B,
et al. Validation of an optoelectric limb
volumeter (Perometer). Lymphology.
1997;30:7797.
218 Ratliff J, Cooper P. Metastatic spine tumors. South Med J. 2004;97:246 253.
219 Maniadaki I, Stiakaki E, Germankis I, Kalmanti M. Evaluation of bone mineral density at different phases of therapy for
childhood ALL. Pediatr Hematol Oncol.
2006;23:1118.
220 Karavatas SG, Reicherter A, White N,
Strong A. Physical therapy management
of patients with multiple myeloma: musculoskeletal considerations. Rehab Oncol. 2006;24:1116.
221 Dimeo F, Tilmann M, Bertz H, et al. Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy
and autologous peripheral stem cell transplantation. Cancer. 1997;79:17171722.
222 Elbl L, Vasova I, Kral Z, et al. Evaluation
of acute and early cardiotoxicity in survivors of Hodgkins disease treated with
ABVD or BEACOPP regimens. J Chemother. 2006;18:199 208.
223 Dang C, Fornier M, Sugarman S, et al. The
safety of dose-dense doxorubicin and cyclophosphamide followed by paclitaxel
with trastuzumab in HER-2/neu overexpressed/amplified breast cancer. J Clin
Oncol. 2008;26:1216 1222.
224 Whitney SL, Wrisley DM, Marchetti GF,
et al. Clinical measurement of sit-to-stand
performance in people with balance disorders: validity of data for the Five-TimesSit-to-Stand
Test.
Phys
Ther.
2005;85:1034 1045.
225 Duncan P, Weiner D, Chandler J, Studenski S. Functional reach: a new clinical
measure of balance. J Gerontol. 1990;45:
M192M197.
226 Oldervoll LM, Loge JH, Paltiel H, et al.
The effect of a physical exercise program
in palliative care: a phase II study. J Pain
227 Berg K, Wood-Dauphinee SL, Williams J,
Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:
304 311.
228 Berg K, Maki B, Williams J, et al. Clinical
and laboratory measures of postural balance in an elderly population. Arch Phys
Med Rehabil. 1992;73:10731080.
229 Shumway-Cook A, Woollacott MH. Motor Control: Theory and Practical Applications. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2001.
Volume 89
Number 3
Physical Therapy f
305

230 Whitney SL, Wrisley DM, Furman J. Concurrent validity of the Berg Balance Scale
and the Dynamic Gait Index in people
with vestibular dysfunction. Physiother
Res Int. 2003;8:178 186.
231 Tinetti M. Tinetti performance-oriented
mobility assessment in elderly patients.
J Am Geriatr Soc. 1986;34:119 126.
232 Podsiadlo D, Richardson S. The timed
up and go: a test of basic functional
mobility for frail elderly persons. J Am
Geriatr Soc. 1991;39:142148.
233 Marchese VG, Chiarello L, Lange B. Effects of physical therapy intervention for
children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2004;42:
127133.
234 Deathe AB, Miller WC. The L Test of
Functional Mobility measurement properties of a modified version of the Timed
Up & Go Test designed for people with
lower-extremity amputations. Phys Ther.
2005;85:626 635.
235 Davis A, Devlin M, Griffin A, et al. Functional outcome in amputation versus
limb sparing of patients with lower extremity sarcoma: a matched case-control
study Arch Phys Med Rehabil. 1999;
80:615 618.
236 Nagarajan R, Clohisy D, Neglia J, et al.
Function and quality-of-life of survivors
of pelvic and lower extremity osteosarcoma and Ewings sarcoma: the Childhood Cancer Survivor Study. Br J Cancer.
2004;91:1858 1865.
237 Rose DJ. Fall Proof! A Comprehensive
Balance and Mobility Training Program. Champaign, IL: Human Kinetics
Inc; 2003.
306
Physical Therapy
Volume 89
238 Dietz JC, Kartin D, Kopp K. Review of

the Bruininks-Oseretsky Test of Motor
Proficiency. Phys Occup Ther Pediatr.
2007;27:87102.
239 Wright M, Halton J, Martin R, Barr R.
Long-term gross motor performance following treatment for acute lymphoblastic leukemia. Med Pediatr Oncol. 1998;
31:86 90.
240 Russell D, Rosenbaum P, Cadman D,
et al. The Gross Motor Function Measure:
a means to evaluate the effect of therapy.
Dev Med Child Neurol. 1989;31:
341352.
241 Palisano RJ, Kolobe TH, Haley SM, et al.
Validity of the Peabody Developmental
Gross Motor Scale as an evaluative measure of infants receiving physical therapy. Phys Ther. 1995;75:939 951.
242 MacLean WJ, Noll R, Stehbens J, et al; the
Childrens Cancer Group. Neuropsychological effects of cranial irradiation in
young children with acute lymphoblastic
leukemia 9 months after diagnosis. Arch
Neurol. 1995;52:156 160.
243 Crisp J, Ungerer J, Goodnow J. The impact of experience on childrens understanding of illness. J Pediatr Psychol.
1996;21:5772.
244 Aass N, Fossa S. Pre- and post-treatment
daily life function in patients with
hormone-resistant prostate carcinoma
treated with radiotherapy for spinal cord
compression. Radiother Oncol. 2005;
74:259 265.
245 Bennett M, Ryall N. Using the modified
Barthel index to estimate survival in cancer patients in hospice: observational
study. BMJ. 2000;321:13811382.
Number 3
246 Yoshioka H. Rehabilitation for the terminal cancer patient. Am J Phys Med Rehabil. 1994;73:199 206.
247 Osoba D, Aaronson N, Muller M, et al.
Effect of neurological dysfunction on
health-related quality of life in patients
with high-grade glioma. J Neurooncol.
1997;34:263278.
248 Reuben D, Siu A. An objective measure of
physical function of elderly outpatients.
J Am Geriatr Soc. 1990;38:11051112.
249 Smith D, Ehde D, Hanley M. Efficacy of
gabapentin in treating chronic phantom
limb and residual limb pain. J Rehabil
Res. 2005;42:645 654.
250 Huang M, Wartella J, Kreutzer J. Functional outcomes and quality of life in patients with brain tumor: a preliminary report. Arch Phys Med Rehabil. 2001;
82:1540 1546.
251 Yates JW, Chalmer B, McKegney FP. Evaluation of patients with advanced cancer
using the Karnofsky performance status.
Cancer. 1980;45:2220 2224.
252 Bergner M, Bobbitt R, Carter W, et al.
The Sickness Impact Profile: development and final revision of a health status
measure. Med Care. 1981;19:787 805.
253 De Bruin A, de Witte L, Stevens F, et al.
Sickness Impact Profile: the state of the
art of a generic functional status measure. Soc Sci Med. 1992;35:10031014.
March 2009

286 Full

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

286 Full

Uploaded by

Copyright:

Available Formats

Perspective

LS Gilchrist, PT, PhD, is Associate

A Framework for Assessment in

GS Morris, PT, PhD, is Director of

Post a Rapid Response or

Assessment in Oncology Rehabilitation

ancer has a high incidence in

tion interventions designed to restore the integrity of organ structure

The ICF Function

Assessment in Oncology Rehabilitation

rements in the activity domain are

school, or work; on the athletic field;

develop unresolved peripheral neuropathy and ankle weakness,31 this

Assessment in Oncology Rehabilitation

The therapist also will want to select

Assessment in Oncology Rehabilitation

though an array of more-complex

of balance for patients with these

Assessment in Oncology Rehabilitation

High-sensitivity cognitive screen

Mini-Mental State Examination

An 11-item questionnaire that is

A 38-item questionnaire that

All populations of patients with

A self-report scale that rates an

Profile of Mood States

Measures 6 mood or affective

Dizziness Handicap Inventory

A 25-item questionnaire that

Computerized gaze stabilization/

A mechanical test that assesses

Modified Total Neuropathy

Mechanical test that quantifies

Mechanical test that quantifies

Visual analog scale

Unidimensional measure of pain

Numeric rating scale

Unidimensional measure of pain

Pediatric cancers168,169; mixed

Faces Pain ScaleRevised171

Intensity measure appropriate for

Sensory functions and pain

Additional sensory functions

Assessment in Oncology Rehabilitation

Brief Pain Inventory

Multidimensional measure of pain;

Adult pain clinic participants,172

Pain Treatment Satisfaction Scale

A 5-item questionnaire that

Mechanical measure, with

Breast cancer,90,91,177 head and

Performance test of generalized

Lymphoma,21 breast cancer181

Manual muscle testing

Standardized performance test

Mechanical measure of force

Mechanical measure of force

National Cancer Institutes

This scale provides standardized

Motor reflex functions

Deep tendon reflexes

A mechanical test that can be

Breast cancer,104 vestibular